Educate juries about the anatomy of auto injuries with our popular Auto Injuries PowerPoint
Whiplash and Methylprednisolone
One of the fundamental problems with whiplash is this: what is the source of the pain and disability. Is it caused by damaged muscle tissue, by facet joint injury, by trauma to the nervous system, or all of the above. A new study sought to examine this problem with a new therapeutic approach.
This study compared two groups of whiplash patients. One group was treated with a high dose of methylprednisolone 8 hours following injury, and the other was given a placebo.
"Methylprednisolone has shown neuroprotective and potent anti-inflammatory effects. In patients with spinal cord injuries methylprednisolone, administered within 8 hours after the trauma, improved recovery and had a neuroprotective effect."
The drug also has analgesic properties, and serious side effects—including peptic ulcers, psychic stimulation, and the drug’s long period of effect. Its use in this study, however, is revealing in regard to whiplash. The researchers stated that they "strictly" followed the same administration procedure of the drug as previously and regularly used in spinal cord injury cases. The motivation for trying this kind of therapy was explained:
"The hypothesis is that chronic symptoms after whiplash injury are not only of musculoskeletal origin, but also could emanate from the central nervous system. Thus, patients with multiple symptoms, including persistent neck pain, dizziness, paresthesia, and cognitive impairment, may have a lesion of the central nervous system, contrary to monosymptomatic patients with intermittent neck pain."
The study displayed significant differences between the placebo and active treatment group of whiplash patients. At the six-month follow-up, only three subjects (15%) reported symptoms and these were intermittent. No members of the treatment group were on sick leave or were still using analgesics.
In the placebo group, four patients (20%) had multiple symptoms requiring daily analgesics and they were still on sick leave.
The researchers found that the total number of sick days for the treatment group (112 days) was significantly less than the total number of days used by the placebo patients (983 days).
The authors suggest many possible mechanisms of injury that may be at work in whiplash and that would explain why this treatment was effective. These potential mechanisms are:
- Brainstem lesions caused by a "pressure-pulse" during the whiplash motion. The motion of the head during a collision creates a large surge of intraspinal pressure, which may result in nerve damage. (For more information, see The Guide to Low Velocity Whiplash Biomechanics, (800) 295-3346.)
- Lesions to the intervertebral discs or facet joints.
In either of these scenarios, methylprednisolone could reduce the inflammation that occurs soon after trauma, and reduce the damage to the affected tissues.
These findings indicate possible benefits of high-dose methylprednisolone treatment, but the authors are cautious about their findings:
"The number of patients studied was small, so further prospective controlled studies are needed. In light of these circumstances, this treatment cannot be recommended until additional studies have verified the results. In addition, it is difficult to select patients who would benefit from this treatment, and that must be weighed against the cost of providing intensive treatment for a large number of patients who sustain an acute whiplash injury."
And the cost of such treatment is very high, as the treatment regimen requires a 24-hour IV infusion of the drug.
Pettersson K, Toolanen G. High-dose methylprednisolone prevents extensive sick leave after whiplash injury. Spine 1998;23(9):984-989.
Please note that this article is copyrighted and may not be reproduced without permission. To include our articles and videos on your website, check out our chiropractic marketing.